Hormone Replacement Therapy (HRT)

Are you worried about menopause? Is estrogen a frightening word for you? Do you have an opinion on hormone-replacement therapy (HRT)?

Well, here is some information you may have been looking for!

Ovary secretes four types of hormones: estrogens, progestogens, androgens, and relaxin. Estrogen has the most diverse physiological effect on the body. It is mainly involved in the development and maintenance of the female sex organs. Its most general effect is to promote tissue growth.

Women, who survive to middle life, experience diminished ovarian function and reduction in hormonal levels resulting in menopause (menstrual pause!). Median age of menopause is 50 years. After menopause, the level of estrogen in blood can fall to 90 percent from their lifetime high.

With menopause come the dreaded symptoms of hot flashes, painful coitus, mild depression and osteoporosis. Osteoporosis affects about 25 percent of the elderly women and is a very serious consequence of menopause. Osteoporosis has been discussed in this column before.

Recently, NEWSWEEK reported that by the year 2000, there will be about 50 million women in America over 50. Many of them will suffer from menopausal symptoms.

Can we treat menopause? Yes, with estrogen (HRT).

For the last 41 years, the most widely prescribed HRT is Premarin – derived from the urine of pregnant mares – containing estrogens. HRT has benefited millions of women control hot flashes and other symptoms of menopause.

Are there any other benefits?

Yes. Women who are on HRT show 20 percent reduction in death rates from all causes including coronary artery disease and some cancers. Risk of having breast cancer is reduced among short term users of estrogen but is worse for women on estrogen for more than 10 years.

Estrogen has a significant positive effect on osteoporosis, delays Alzheimer’s disease, and reduces by half the chance of dying from colon cancer.

But remember the protective effect is there as long as the woman is on HRT and upto 5 years after it has been discontinued.

If HRT is so wonderful then why doctors ask: “To prescribe or not to prescribe”; and post-menopausal women ask: “To take or not to take”?

The answer is simple – the fear of acquiring breast and uterine cancer. As one of the functions of estrogen is to promote tissue growth.

But the good news is that addition of another hormone (progestin) to estrogen can substantially reduce the risk of uterine cancer.

New drugs like SERMs (selective estrogen receptor modulators) are being developed. They selectively work on bones, heart and brain but not on the breast or uterine tissues. Thus eliminating the risk of cancer in these areas.

In some cases the benefits of HRT therapy far outweigh the risks. A lot depends on your personal and family history of heart disease and breast cancer and the severity of post-menopausal symptom like hot flashes and risk of osteoporosis.

NEWSWEEK says: …….until the perfect SERM comes along, women must weigh the pros and cons of estrogen. This reminds me of what my wife always says: A woman’s work is never done….there is always something to worry about!

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